by Sven Löffeler

Author: Sven Löffeler

Christmas is over. And a very different Christmas to boot. I am back in Norway, probably the most quiet and peaceful country in the world. Back to snow and ice and winter darkness. Back to a place where catastrophe and tragedy are strangers to most and familiar only to the few.

The contrast could not be greater to Bangladesh where I spent Christmas and New Year. Near the border to Myanmar, in the far east corner of Bangladesh, in one of the poorest parts of the country, a refugee camp has sprung up that is most likely the largest in the world. 850 000 people – men, women and children – live under conditions that can only be described as abominable. Some of them have lived there since 1994 when the first wave of refugees spilled across the border from Myanmar. The great majority has arrived since august when the violence in their home country forced them to pack up and flee. I had seen the footage of the exodus on TV before leaving and I had seen the photos of the refugee camp stretching for miles and miles across the once wooded hills of Chittagong province.

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Can you discuss prostate cancer without mentioning PSA? No, you cannot. Two years ago I shared an article on Richard Ablin, who discovered the Prostate-specific antigen (PSA) forty years ago. Ablin, the father of the famous test, believes that the medical profession has turned it into a monster. While this is an exaggeration, PSA testing and screening has certainly changed the landscape of prostate cancer beyond recognition. And it may have created more problems than it has solved.

This is the PowerPoint slide I always show when I give lectures for prostate cancer patients: PSA, the superhero among the cancer markers? Yes indeed. There is simply no other tumor marker around that gives you a better picture of therapy success or failure (what is PSA?). Continue reading →

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It is April 26th. As I watched the evening news last night, it hit me: It’s been a year since the great catastrophe that devastated parts of Nepal, the small country clinging precariously to the foothills of the Himalayas. The earthquake (or rather quakes) left one of the poorest countries on the planet in an impossible situation. Unfortunately, it is painfully obvious that the rebuilding process is not on track and most of the displaced and the homeless still live in temporary shelters. I was part of the relief effort last year working at the Norwegian Red Cross Field hospital at Chautara for a month. The question I cannot help to ask is: Have we failed?

I didn’t write about my stay in Nepal when I returned home ten months ago and I have put it on hold since. I’m not really sure why. There have been lots of other things on my mind and I was optimistic about the prospects of rebuilding the country and it felt redundant somehow. I feel bad about it now, since the way things have turned out, keeping Nepal on people’s minds is important. So this is my belated contribution. Continue reading →

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What is prostate cancer? First of all, it is a devastating disease which claims the life of many men, is difficult to treat and often impossible to stop. And on the other hand, prostate cancer is a condition which doesn’t cause symptoms, let alone kill patients and probably shouldn’t be called cancer at all. Confused? I hope you are. It is a good starting point for understanding prostate cancer.

First of all, why am I doing this? I am a urologist and I’ve been treating prostate cancer patients for over a decade. What sticks out among many lessons is that prostate cancer patients need to have a far more profound and in-depth understanding of the nature of their disease than other cancer patients. Why? We’ll get to that.

The author with the Norwegian Minister of Health, Bent Høie, visiting the Prostate Center at Vestfold Hospital Trust.

This understanding, however, is regularly sabotaged by media coverage of the disease which invariably focuses on new and usually fancy treatments rather than the bits of information which really matter to patients. So every time prostate cancer is on the news, I have to use a lot of extra time and effort with my patients to put things into perspective again. So this blog is my (probably forlorn) effort to convey the messages I think are important . I work at a non-academic central hospital where I’m exposed to the whole spectre of the disease. I cannot select the patients I want to see. I have to deal with all of them and with every aspect of the disease. I follow them from their first biopsy and in some instances to their death. It is both a privilege and a challenge.

Three years of waiting have come to an end. It was in november 2010 that I started my Red Cross training and I have been a delegate, ready to be deployed as a surgeon for two and a half years. I have completed online courses, have lived through seven days of a simulated mission in the woods of Eidene, Norway, where we built up a field hospital and trained the practical aspects of being on a mission (ERU course). I have done the IMPACT course, another seven days of learning about the Red Cross movement, its structures and its goals and purpose. I was ready! Very, very ready to be deployed. But then, instead, came the long void: Luckily for planet earth, major disasters which would warrant deployment of a field hospital, just didn’t seem to happen anymore. ‘Well, great!’ the humanitarian in me thought and…

“Many men get treated unnecessarily – and risk life-altering side effects including impotence and incontinence”

Pathologist Richard Ablin discovered the PSA antigen 40 years ago. He says it should never have been used as a cancer screening tool for all men

Your book condemns the use of PSA for cancer screening. What do you hope to accomplish? I hope to expose how the urology community and drug industry misused the PSA test, putting money over the best interests of patients. I also want to show how the US Food and Drug Administration failed in its duty to the public: its advisers warned that routine PSA screening would cause a public health disaster, but it was approved under pressure from advocacy groups and drug companies.

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After the first ten days I feel more at ease. Things that looked exotic and strange to me a week ago seem now familiar. The days pass in a predictable pattern and we don’t get called out at night anymore. We usually set up our surgeries the day before which gives me ample time for preparation. Routine kicks in and I can slowly reclaim my comfort zone.

The on-calls are still a bit of a nuisance though. Most patients that are admitted at night have medical conditions which I have forgotten all about and so I have my nose buried deep in the books of medical wisdom every time an asthma or hypertension patients enters the tent. We are five doctors and thus on-call every fifth night and that means we spend 34 hours at the hospital. We are not overwhelmed by work during these night shifts, but it isn’t easy to get good sleep either. We are supposed to sleep in a mosquito dome in the admin tent which happens to be located right adjacent to the main street. Despite the fact that Basey is a quiet town by Asian standards, they manage to keep up quite an impressive noise level: First there are the motorcycles and the stereos that spit out endless streams of old and new love songs in dubious sound quality. The Philippinos really like their softpop songs, which is one of the few things I have to hold against them.

St. Michael’s Church in Basey, Samar, constructed in the 17th century by Spanish friars

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My first night has been warm and humid. My only cover is a sheet and even that is too warm. My pillow is soaking wet from my sweat. The team before us bought in ventilators with one of these miracle machines placed in each tent and they give at least some respite from the heat. It is only four o’ clock in the morning, but I’m wide awake. I don’t know it yet, of course, but this is going to be a permanent feature: Early beds and up at sparrow’s fart. I take a quick cold shower (warm showers are not available right up to the end of my stay) and then we eat breakfast just after dawn at 6.30 am (again rice, with eggs or every now and again some meat) and then the first bus leaves for our field hospital at 7.15 am. ICRC rules are strict: No delegate is allowed to drive, all transport of personnel is done by well-instructed and carefully selected drivers. The reason for this is, of course, that most injuries and fatalities among delegates on international missions are due to traffic accidents. As for my other worries, by the way: The NPA has declared a cease-fire and is nowhere to be seen; there is absolutely no looting, and I haven’t seen any spiders or snakes yet. The dengue mosquitos, meanwhile, are kept at bay by abundant layers of insect repellent. I feel a bit stupid now for worrying at all, but I quickly decide to blame it on the jet-lag. No reason to suffer unnecessary dents in my self-confidence at this early stage. By the way, there is no Malaria on Samar and I choose therefore not to take any prophylaxis.

The ICRC Field Hospital, located in the basketball hall of Basey (photo by Norwegian Redcross)

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Three years of waiting have come to an end. It was in november 2010 that I started my Red Cross training and I have been a delegate, ready to be deployed as a surgeon for two and a half years. I have completed online courses, have lived through seven days of a simulated mission in the woods of Eidene, Norway, where we built up a field hospital and trained the practical aspects of being on a mission (ERU course). I have done the IMPACT course, another seven days of learning about the Red Cross movement, its structures and its goals and purpose. I was ready! Very, very ready to be deployed. But then, instead, came the long void: Luckily for planet earth, major disasters which would warrant deployment of a field hospital, just didn’t seem to happen anymore. ‘Well, great!’ the humanitarian in me thought and started accommodating to this situation. What can be better! But then typhoon Yolanda hit the Philippines, and what seemed like a remote possibility, namely being deployed to a disaster area as a surgeon, suddenly turned into a very real prospect. Ever since Norwegian Red Cross headquarters called me in the middle of december, I knew I was going to head for the Philippines on New Years day.

I have finally arrived in the country where my first mission will take place. I am headed for the Visayas, namely the island of Samar, where typhoon Yolanda, which is called Haiyan in the rest of the world,has left vast strips of coast devastated and in ruins. Unprecedented winds and a giant wave, that came in the wake of the storm, have left an impoverished population even poorer and more destitute than ever. Millions of people have lost everything in the storm. Millions of homes are destroyed.

At my hotel room in Manila, waiting to move on to Basey

I am restless, pacing my room at the rather posh Somerset Millenium Apartment Hotel in the rather posh Makati district of Manila. The setting is a bit unreal, nothing in this big and vibrant city even hints at the catastrophe which has beset the southern islands of the archipelago. Life in this metropolis, which tries desperately to be as American as possible, couldn’t be more normal.